Liam’s lump: A family faces surgery

Liam, who had a thyroglossal duct cyst, poses with his older brother.
Liam, left, and his older brother Nolan (PHOTOS COURTESY OF LIAM’S FAMILY)

Liam likes to move fast. He rides his bike fast, kicks the soccer ball fast, and swings fast on the swing set. At the local pool, his cannonballs are bigger because of his fast running start. “Liam is the wild man in our family,” says his mom Julie. “Nothing seems to scare him.”

Liam was taking a swim lesson when something strange caught Julie’s eye. “He was floating on his back and I noticed a lump on his neck, just under his chin,” she says. “I thought, ‘That does not look right.’”

An unusual lump

Within days, Julie and Liam were in the pediatrician’s office. Liam’s doctor advised keeping an eye on the lump for a couple of weeks to see if it would get smaller on its own. Three weeks later, Liam’s lump had changed little and the pediatrician referred the family to Dr. Michael Cunningham at Boston Children’s Hospital.

“Dr. Cunningham examined Liam and told us the lump was likely a benign cyst of some sort,” says Julie. “He also said it should be removed.”

Liam, who had a thyroglossal duct cyst, poses as a cow at a visit to a farm.

Benign cysts of the neck are fairly common in children. Many times, such cysts begin to develop before a baby is born. Thyroglossal duct cysts, which it turned out Liam had, begin to form in the womb. At a certain stage of development, the thyroid gland travels from the back of the mouth to its permanent spot in the lower neck. Typically, this path then closes up, but sometimes it remains partially open. After the child is born, this open passageway can fill with fluid and form a cyst.

Cunningham told Liam’s parents that left untreated, the cyst could continue to enlarge and become infected. They scheduled surgery for the end of May.

Preparing for surgery

Liam knew he had a mass on his neck. “He called it ‘my lump,’ with an emphasis on the letter L,” says Julie. Still, she and her husband Garrick worried about how much to tell their 4-year-old son and his 7-year-old brother Nolan. “We wanted to be as honest and open as possible without upsetting them with too much detail.”

Pamphlets from Boston Children’s helped the couple decide how much information each boy could handle based on his age. It also helped that their father had had three surgeries as a kid: eye surgery and surgeries to remove his tonsils and adenoid. “It made things less scary that he could talk about his experience and answer the boys’ questions,” says Julie.

Liam, who had a thyroglossal duct cyst, poses with his family on a train.

On the day of Liam’s surgery, his father carried him into the operating room and held him on his lap while he received a sedative through a marshmallow-flavored mask (Liam got to choose the flavor.) When Liam was asleep and the surgery was ready to begin, Garrick joined Julie in the surgical waiting area.

Based on their conversations with Cunningham, the couple understood Liam might have to stay in the hospital overnight, depending on how things went. But by 3 that afternoon, they were all back home. By dinnertime, Liam was outside, playing with his brother.

Back to play and school

Lab results showed Liam’s thyroglossal duct cyst was benign, as Cunningham had predicted. Three days after procedure, Liam was back in nursery school.

The story of Liam’s lump and the surgery to remove it has become a piece of family lore; something Julie and Garrick remember clearly. Liam, on the other hand, has moved on. After all, he has more important matters to think about, like playing Legos with Nolan and making the biggest splash possible when he cannonballs into the pool.

Learn more about the Department of Otolaryngology and Communication Enhancement.